Read 2010 TourDeScranton Brochure.indd text version

Registration and Payment

Registration Fee: $30 - before April 18th $35 - after April 18th $35 - day of event $50 - Parent and their children under 12 (one charge) Register online at www.tourdescranton.com Please complete one form per person (OK to photocopy and give to friends). Don't forget to sign the release and return it with your registration form.

Please print legibly on top line

Name Address City Area Code Telephone # State Zip Code

PLEASE INDICATE COURSE OF CHOICE

____ 1. ROUTE 1 Starting at Scranton High School, proceed to Valley View Elementary School in Peckville, and return to Scranton High School ( 15 miles approx) ROUTE 2 Starting at Scranton High School, to Valley View Elementary School, to Carbondale Area High School, and return to Scranton High School (32 miles approx ROUTE 3 Starting at Scranton High School, to Valley View Elementary School, to Carbondale Area High School, to Forest City High School and return to Scranton High School (46 miles approx) More scenery and climbing ROUTE 4 Metric Century: This route is for the serious cyclist. We will by-pass the stops and turns of the original tour routes and head right out to the country. Several aid stations will be available, including one at Lakeland High School; Plenty of climbs and beautiful country side (65 miles approx) Cue sheets will be provided.

____ 2.

____ 3.

____ 4.

Email Address:

Water, snacks, and food: School _______________

Water and snacks provided at start and at rest stops along each route. Bring water bottles. Rest stops with snacks are noted on your cue sheets. Food and drinks will be available at the end of the bike ride.

Age _______

Route Choice #____________ Youth T-Shirt Adult T-shirt L __ S__ Med__ L__ XL__

Support Services:

Telephones, Rest Rooms, Parking. Several local bike shops have been invited to offer technical assistance. They will offer regular checks, assistance, or anything of a minor repair.

__ I cannot participate, but please accept my donation ___________ Return this form and release with your pledge sheet by April 18, 2010 to insure availability of a T-shirt and gift bag. Make check payable to: "Erin's Fund" Mail completed form and release to: Mr. & Mrs. Thomas Moreken 1328 Myrtle Street Scranton, PA 18510

Date: April 25, 2010

Registration

Time: 9:00 a.m Start Time for All Routes: 10:00

Tour de Scranton T-shirts should be worn during the ride.

Questions? Volunteer opportunities? Route Maps www.tourdescranton.com

BENEFITS THE ERIN JESSICA MOREKEN DRUG & ALOCHOL TREATMENT FUND, INC.

For Info: www.tourdescranton.com

The Tour de Scranton....

The Tour de Scranton is an annual noncompetitive bike ride for riders of every age and skill level. Designed with a selection of routes and distances catering to both the novice and experienced rider, anyone can bring a bicycle and join in the fun. The Tour de Scranton also benefits an extremely good cause.... The Erin Jessica Moreken Drug & Alcohol Treatment Fund, Inc. This fund was established in 2002 in memory of Erin, who died at the age of 28 following a drug overdose. You can help raise money for this fund by securing pledges for your ride. A pledge sheet is provided and should be turned in with your application by April 19th. Riders with pledges of $50 or more are eligible to win one of two bikes which will be awarded at the conclusion of the event. Riders with pledges of $100 or more are eligible to win one of many gift certificates or prizes which will be awarded following the event. The bike ride will be monitored from start to finish by adult volunteers and cyclists at regular check points. It is a safe and enjoyable way to have fun and raise the much needed funding to assist young people who are struggling with the disease of addiction.

Erin Jessica Moreken

The

Release

(must be signed in order to ride)

In consideration of my being able to participate in this event, I hereby for myself, my heirs, executors, administrators and assigns, waive, release and forever discharge any and all claims I may now or in the future have against the Erin Jessica Moreken Drug and Alcohol Treatment Fund, its administrators, event volunteers, sponsors and any other persons connected with this ride, for any liability, for personal injury, illness, death, or property damage sustained by me resulting from my participation in this ride except to the extent that it is caused by gross negligence. In the event that such injury, illness, death or damage is caused by gross negligence, this release remains operative as to any released person or entity which was not grossly negligent. Further, as a participant in this Bike Ride, I assure the following: 1. I am in good health and able to complete the ride. 2. I am able to participate in this ride and am sufficiently prepared and experienced to take this ride. 3. My bicycle equipment is in good working order and has the proper safety equipment. 4. I have been made aware that a bicycle helmet should be worn. 5. I will obey the motor vehicle and bicycle laws of PA. 6. I will obey the following practices during the ride: a) be alert; b) signal my intentions; c) know my limits; d) not ride too close. 7. I understand that participants under the age of 10 must be closely supervised by an adult at all times during the ride. 8. If injured or disabled on the ride, or if I cause any injury, loss or damage, I will promptly alert the bike ride organizers. 9. I recognize the hazards inherent in the activity of bicycling, including the risks of serious bodily injury and death, and I never-the-less undertake this activity voluntarily. 10. I have read and understand all of the above rules and ride practices. 11. I also agree to the use of film, photo, or videotape of the event for any purpose.

Drug and Alcohol Treatment Fund, Inc.

Each year through this event, we have been able to offer scholarships, aid, and drug and alcohol educational programs to a variety of worthy individuals and groups in our community. Pledges to Erin's Fund will help to fulfill our Mission Statement: "The Erin Jessica Moreken Drug & Alcohol Treatment Fund, Inc. was established to provide charitable gifts to qualified organizations or individuals struggling with the disease of addiction."

Signature of Applicant ______________________________Date___________ Print Name: _____________________________________________________

Signature of Parent or Guardian if under 18 Date Print Name: ______________________________Relationship:____________ In emergency, contact: ____________________________________________ Print Name Relationship Emergency Phone: _______________________(home) ________________________(work) Email Address ____________________________________________________

BICYCLE HELMETS MUST BE WORN WHEN RIDING!

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2010 TourDeScranton Brochure.indd